HomeMy WebLinkAboutS2018-0206 - Permit ApplicationWORKSHEET FOR POOL COMBINATION PERMIT APPLICATION
u CITY OF NEWPORT BEACH
BUILDING DIVISION C n I G ,179111 0
PLEASE PRINT OR TYPE L2 /iv 1 o - vv v4
1. PROJECT ADDRESS (NOT MAILING ADDRESS)
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LEGAL DESCRIPTION
LOT BLOCK TRACT
2. DESCRIPTION OF WORK
ESTIMATED $ VALUATION
SWIMMING POOL ❑ SPA POOL FENCING ❑ DRAINAGE ❑
Check Appropriate box for Applicant
3. OWNER'S NAME LAST FIRST
ADDRESS
OWNER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
4. ENGINEER'S NAME L 5T FIRST
LICENSE N
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ADDRESS
ENGINEER'S E-MAIL ADDRESS
CITY STATE ZIP
PHONE NO.
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5. CONTRACTOR'S NAME MISS � � tL
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BUSINESS LICENSE
STATE LICENSE
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No.
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ADDRESS � %QQ
CONTRACTOR'S E-MAIL ADDRESS
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CITY STATE ZIP
PHONE NO.
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OFFICE USE ONLY
PERMIT NO.
PLAN CHECK NO.
POOL P/C FEE $
DRAINAGE P/C FEE $
Forms\Pool spa appl (rev3-04).xls
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